Ruminating over Recent Results – Renewing My Resolve

An article by yuv90

Hello friends et al,

It is with a heavy heart that I write this blog post. For those who may be reading this in the future, my anguish is with reference to the recent US elections, where, as it stands, Donald Trump, the republican nominee, is the current President-Elect [2017-2020]. Further, the US senate, House of Representatives, and the Supreme Court are in line to be dominated by the Republican Party.

To understand why this is so disturbing (to me), one needs to understand the undertone of the campaign. To put it simply the current president-elect has previously demonstrated, unequivocally, that he has a racist, bigoted, and sexist demeanor. There is absolutely no way anyone can sensibly argue otherwise. This has a large amount of people with a spectrum of emotions [indifference, anguish, anger, fear]. Although this is the expected response of a losing party in a bipartisan election, this time is different. In the past, presidential nominees were expected to be presidential in character; to be – at the very least – reasonable, firm of opinion, inspiring or considerate. However a quick review of his Twitter account, leaves little to the imagination. To be frank, if any other reasonable person had proposed the same message to the people [which has been inconsistent even post-election] and won, it would be easier to accept. But, his continuous attempts to target individuals and baselessly attack them on Twitter is troubling.

The recent US election was extremely polarizing. In my opinion, one of the biggest reasons was the lack of delineation between fact and opinion. With social media at it’s current state, it is easy for anyone to believe anything. All it takes is 1) a nidus of thought, and, 2) a few people or references (of varying dubiousness) to back up an opinion. Once those are in place, social media can popularize the opinion until it is treated as fact. [1]

This is similar to propaganda on an uninhibited, rapid scale. The difference here is that this is done on an individual, unpredictable level, instead of via a deliberate, controlled plan. The exponential speed at which information can spread is alarming, and, we need to find a better way to enable fact-checking and discourage false information from spreading. This is one reason as to why people like our current President-Elect continue to deny global warming, even in the face of evidence [2].

Personal reflections aside, I want to attempt to discuss the potential impacts our current environment will have on equitable health. For convenience, I will split it up as equitable health in the US, and, internationally.

In the US, one of the major stance’s Trump held was that he was going to repeal Obamacare completely. While it is true that premiums have increased with the Affordable Care Act [ACA], it has also created the lowest uninsured rate in the country [3]. Repealing it will cause huge disadvantages to several patient populations.

Further, their current stance is to decentralize Medicaid and remove federal funding[4]. A number of states [Kentucky, for example {5}] depend on federal funding for Medicaid, and, with decentralization, many individuals will likely lose coverage. [6]

Further, CMMI [The Center for Medicare and Medicaid Innovation] was created through the ACA. CMMI resulted in the Medicare Access and CHIP Reauthorization Act [MACRA], that is going into effect in January 2017. MACRA, in it’s current form, is designed to create a new payment model that transitions from fee-for-service to merit based incentives. MACRA will enable higher quality care through incentives, and, will hopefully be a welcome change for healthcare. Although MACRA will not be repealed with the proposed repeal of the ACA, portions of the merit based incentive system that allowed for Advanced Alternative Payment systems may go away as they were being created through the CMMI. These Advanced Alternative Payment systems were to be created to enable smaller practices and other practices to comply with MACRA through new and innovative means.

Simply put, completely repealing the ACA, as was initially proposed, will cause much chaos and angst if there is no clear alternative plan in place.

As an aside, here are some of the things that our president-elect has said publicly on twitter back in 2014

I realize that this is a long post and there is a lot of information to process. Therefore, I will add more info with regard to the potential impact on international equitable health in a follow up post, due shortly. In the interim, I would ask readers to read this reference for more information [7]

A lot of what I have stated above is discouraging. And now that I have given myself time to process the change, I am becoming to develop a new resolve. I will also spend a portion of my follow up blog post on ways that we can work together towards better equipping ourselves and better serving the vulnerable.

Until next time,

Yuvaram

Please note: The above opinions are entirely my own, and, do not reflect upon the other authors of this blog, or, of Boston Medical Center.

2 comments on “Ruminating over Recent Results – Renewing My Resolve”

You nicely tackle some of the understandable political and health concerns many have post-election (and I appreciate that you note the separation between your opinions and those of BMC!). I’ll just add that part of the issue we now face is uncertainty – given Trump’s record of switching plans, it’s hard to know where our health system is going (let alone foreign aid), which has huge implications for the executive teams of health systems. BMC’s own transition to ACO depends in part on MACRA related support, as I understand it – I am very curious to see what is done by C-suites across the country while they await more information as to what, if anything, will happen to the ACA.